Peri-operative hyponatremia in orthopaedic injury patients

Channa reddy H, Ambrish Sharma


Introduction: Hyponatremia is a common electrolyte disorder, particularly in orthopeadic trauma surgery patients and associated with adverse clinical outcomes. The aim of the study is to define the patient demographics, associated risk factors and clinical outcomes. Methods: We evaluated patients admitted with major orthopeadic trauma in a tertiary care academic institution. Elderly patients morethan 65 years, who developed hyponatremia pre-operatively or post-operatively were included in the study. Basic demographic data, risk factors for, medication use, duration of hospital stay, in patient deaths were recorded. Results: Thirty patients were included. Mean age is 72.4 years. There were 20 females (66.6%). Risk factors (comorbidities) that cause hyponatremia were present in 73.3% (n=22). The most common comorbidities are hypertension 53.3% (n=16), DM 26.6% (n=8), CRF 16.6% (n=5), heart disease 16.6% (n=5). Drug induced hyponatemia is frequently caused by thiazide diuretics 20% (n=6) and anti-depressants 20% (n=6).The mean serum sodium pre-operatively 132.33 mmol/L (range 122-139) and mean post-op sodium level of 126.26 mmol/L (range 113-133) with mean post-op sodium level drop of 6.07 mmol/L. Twenty one patients had mild to moderate hyponatremia. The most frequent symptom was disorientation 40% (n=12), nausea and vomiting 26.6% (n=8), headache 10% (n=3) and seventeen percent (n=5) of the subjects were asymptomatic. The mean duration of hospital stay was 15.7 days (range 5-42 days), seven patients (23.3%) required ICU care and 2 patients (6.6%) died in the hospital. Conclusion: The most common risk factors that cause hyponatremia are hypertension and diabetes. Diuretics and antidepressant drugs are common causative factors. Average decrease in serum sodium level post operatively should be expected in this age group.  Majority had mild to moderate hyponatremia. Total length of the hospital stay (TLOS) is increased compared to normal discharge. Mortality rate is also higher.

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